Plans and providers have certain responsibilities related to notifying beneficiaries of Medicare appeal rights. If a Medicare health plan denies service or payment, in whole or in part, the plan is required to provide the enrollee with a written notice of its determination. Additionally, Medicare health plan enrollees receiving covered services from an inpatient hospital, skilled nursing facility, home health agency, or comprehensive outpatient rehabilitation facility have the right to a fast, or expedited, review if they think their Medicare-covered services are ending too soon.

The Centers for Medicare & Medicaid Services (CMS) is readying a fraud prevention initiative that removes Social Security numbers from Medicare cards to help combat identity theft, and safeguard taxpayer dollars. The new cards will use a unique, randomly-assigned number called a Medicare Beneficiary Identifier (MBI), to replace the Social Security-based Health Insurance Claim Number (HICN) currently used on the Medicare card. CMS will begin mailing new cards in April 2018 and will meet the congressional deadline for replacing all Medicare cards by April 2019. Today, CMS kicks-off a multi-faceted outreach campaign to help providers get ready for the new MBI.

Q: Our radiology department is requesting that we add a new modifier to their charge description master (CDM), modifier –CT (computed tomography [CT] services furnished using equipment that does not meet each of the attributes of the National Electrical Manufacturers Association [NEMA] XR-29-2013 standard). They want this added to the CT scan line items, but they are not sure if it is for all of the items or only certain ones. Can you provide more information that might help us know how to proceed?

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Medicare Compliance Essentials Training Compendium

Ensure compliance across your organization at an affordable price.

HCPro has brought together seven of its most popular Medicare compliance training handbooks into a single collection, offering Medicare professionals a one-stop resource for regulatory and practical guidance. The Medicare Compliance Essentials Training Compendium is a full-size book featuring a brand-new introduction with guidelines on using the content and tools in each handbook for training purposes. The individual handbooks can also be downloaded and printed for training unlimited numbers of staff.

Developed by industry-leading experts, this compendium simplifies Medicare compliance by providing a go-to source for training on critical billing and reimbursement issues, helping to ensure the delivery of a unified message throughout the organization. The book and downloadable handbooks cover topics such as:

*MAGNET™, MAGNET RECOGNITION PROGRAM®, and ANCC MAGNET RECOGNITION® are trademarks of the American Nurses Credentialing Center (ANCC). The products and services of HCPro are neither sponsored nor endorsed by the ANCC. The acronym "MRP" is not a trademark of HCPro or its parent company.